Relationship between gamma-glutamyl transferase/albumin ratio and coronary slow flow phenomenon

Uğur Küçük 1 * , Kadir Arslan 1
More Detail
1 Department of Cardiology, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 19, Issue 2, pp. 48-52.
Download Full Text (PDF)


Aim: The coronary slow flow phenomenon (CSFP) is a pathology characterized by decreased coronary flow without stenosis on angiographic imaging. It is known that gamma-glutamyl transferase (GGT) and albumin play a role in cardiovascular disease. Our aim was to investigate whether GGT-to-albumin ratio could predict CSFP.
Material and methods: Our cross-sectional study included 149 patients who had myocardial ischemia and underwent coronary angiography in our clinic. Our study consisted of two groups, with and without CSFP. The GGT-to-albumin ratio values were compared between the groups, and the presence of a risk factor for CSFP was evaluated with a regression analysis.
Results: A statistical significance was observed between the groups with and without CSFP in terms of GGT-to-albumin ratio values, (6.16 and 4.46, respectively; p<0.001). There was a moderate correlation between GGT-to-albumin ratio and the mean thrombolysis in myocardial infarction frame counts (r=0.423, p<0.001). In the univariate logistic regression analysis revealed that GGT-to-albumin ratio was predictive of CSFP [odds ratio: 0.460, 95% confidence interval (CI): 0.341–0.620, p<0.001]. In the receiver operating characteristic curve analysis performed on GAR to distinguish CSFP, the GGT-to-albumin ratio exhibited 84% sensitivity and 59% specificity for values ≥4.67 (area under the curve: 0.78, 95% CI: 0.708–0.859, p<0.001).
Conclusion: GGT-to-albumin ratio values were found to increase in the presence of CSFP. Our findings advise that GGT-to-albumin ratio might also play a function inside the pathogenesis of CSFP.


Küçük U, Arslan K. Relationship between gamma-glutamyl transferase/albumin ratio and coronary slow flow phenomenon. J CLIN MED KAZ. 2022;19(2):48-52.


  • Beltrame JF, Limaye SB, Horowitz JD. The coronary slow flow phenomenon--a new coronary microvascular disorder. Cardiology. 2002;97(4):197-202.
  • Saadat M, Masoudkabir F, Afarideh M, Ghodsi S, Vasheghani-Farahani A. Discrimination between Obstructive Coronary Artery Disease and Cardiac Syndrome X in Women with Typical Angina and Positive Exercise Test; Utility of Cardiovascular Risk Calculators. Medicina (Kaunas). 2019;55(1):12.
  • Serné EH, de Jongh RT, Eringa EC, IJzerman RG, Stehouwer CD. Microvascular dysfunction: a potential pathophysiological role in the metabolic syndrome. Hypertension. 2007;50(1):204-11.
  • Danaii S, Shiri S, Dolati S, Ahmadi M, Ghahremani-Nasab L, Amiri A et al. The Association between Inflammatory Cytokines and miRNAs with Slow Coronary Flow Phenomenon. Iran J Allergy Asthma Immunol. 2020;19(1):56-64.
  • Hawkins BM, Stavrakis S, Rousan TA, Abu-Fadel M, Schechter E. Coronary slow flow prevalence and clinical correlations. Circ J. 2012;76(4):936-42.
  • Topal S, Kızıltunç E, Sezenöz B, Candemir M, Ünlü S, Küçükbardaslı M, et al. Gamma-glutamyl transferase to albumin ratio can predict severity of coronary artery disease detected by coronary computed tomography angiography. Anatol J Cardiol. 2021;25(9):653-60.
  • Emdin M, Pompella A, Paolicchi A. Gamma-glutamyltransferase, atherosclerosis, and cardiovascular disease: triggering oxidative stress within the plaque. Circulation. 2005;112(14):2078-80.
  • Pleiner J, Mittermayer F, Schaller G, Marsik C, MacAllister RJ, Wolzt M. Inflammation-induced vasoconstrictor hyporeactivity is caused by oxidative stress. J Am Coll Cardiol. 2003;42(9):1656-62.
  • Münzel T, Gori T, Keaney JF Jr, Maack C, Daiber A. Pathophysiological role of oxidative stress in systolic and diastolic heart failure and its therapeutic implications. Eur Heart J. 2015;36(38):2555-64.
  • Korantzopoulos P, Kolettis TM, Galaris D, Goudevenos JA. The role of oxidative stress in the pathogenesis and perpetuation of atrial fibrillation. Int J Cardiol. 2007;115(2):135-43.
  • Paar M, Rossmann C, Nusshold C, Wagner T, Schlagenhauf A, Leschnik B et al. Anticoagulant action of low, physiologic, and high albumin levels in whole blood. PLoS One. 2017;12(8):e0182997.
  • Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996;93(5):879-88.
  • Zhu Q, Zhao C, Wang Y, Li X, Xue Y, Ma C. LncRNA NEAT1 Promote Inflammatory Responses in Coronary Slow Flow Through Regulating miR-148b-3p/ICAM-1 Axis. J Inflamm Res. 2021;14:2445-63.
  • Zhang X, Ding J, Xia S. A preliminary study of MMP-9 and sCD40L in patients with coronary slow flow. Ann Palliat Med. 2021;10(1):657-63.
  • Sezgin AT, Sigirci A, Barutcu I, Topal E, Sezgin N, Ozdemir R et al. Vascular endothelial function in patients with slow coronary flow. Coron Artery Dis. 2003;14(2):155-61.
  • Zhu X, Shen H, Gao F, Wu S, Ma Q, Jia S et al. Clinical Profile and Outcome in Patients with Coronary Slow Flow Phenomenon. Cardiol Res Pract. 2019;2019:9168153.
  • Lemoine M, Shimakawa Y, Nayagam S, Khalil M, Suso P, Lloyd J et al. The gamma-glutamyl transpeptidase to platelet ratio (GPR) predicts significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa. Gut. 2016;65(8):1369-76.
  • Paolicchi A, Minotti G, Tonarelli P, Tongiani R, De Cesare D, Mezzetti A, et al. Gamma-glutamyl transpeptidase-dependent iron reduction and LDL oxidation--a potential mechanism in atherosclerosis. J Investig Med. 1999;47(3):151-60. PMID: 10198571.
  • Victor VM, Rocha M, Solá E, Bañuls C, Garcia-Malpartida K, Hernández-Mijares A. Oxidative stress, endothelial dysfunction and atherosclerosis. Curr Pharm Des. 2009;15(6):2988-3002.
  • Arasteh S, Moohebati M, Avan A, Esmaeili H, Ghazizadeh H, Mahdizadeh A et al. Serum level of gamma-glutamyl transferase as a biomarker for predicting stenosis severity in patients with coronary artery disease. Indian Heart J. 2018;70(6):788-92.
  • Ruttmann E, Brant LJ, Concin H, Diem G, Rapp K, Ulmer H; Vorarlberg Health Monitoring and Promotion Program Study Group. Gamma-glutamyltransferase as a risk factor for cardiovascular disease mortality: an epidemiological investigation in a cohort of 163,944 Austrian adults. Circulation. 2005;112(14):2130-7.
  • Fanali G, di Masi A, Trezza V, Marino M, Fasano M, Ascenzi P. Human serum albumin: from bench to bedside. Mol Aspects Med. 2012;33(3):209-90.
  • Pasini E, Aquilani R, Gheorghiade M, Dioguardi FS. Malnutrition, muscle wasting and cachexia in chronic heart failure: The nutritional approach. Ital Heart J. 2003;4(4):232‑5. PMID: 12784775.
  • Chien SC, Chen CY, Leu HB, Su CH, Yin WH, Tseng WK et al. Association of low serum albumin concentration and adverse cardiovascular events in stable coronary heart disease. Int J Cardiol. 2017;241:1-5.
  • Refaat H, Tantawy A, Gamal AS, Radwan H. Novel predictors and adverse long-term outcomes of No-reflow phenomenon in patients with acute ST elevation myocardial infarction undergoing primary percutaneous coronary intervention. Indian Heart J. 2021;73(1):35-43.
  • Liu Y, Ye T, Chen L, Jin T, Sheng Y, Wu G et al. Systemic immune-inflammation index predicts the severity of coronary stenosis in patients with coronary heart disease. Coron Artery Dis. 2021;32(8):715-720.
  • Shannon CM, Ballew SH, Daya N, Zhou L, Chang AR, Sang Y et al. Serum albumin and risks of hospitalization and death: Findings from the Atherosclerosis Risk in Communities study. J Am Geriatr Soc. 2021;69(10):2865-76.